Top Claims Executive plans and directs all aspects of an organization's insurance claims function. Responsible for managing and implementing claims programs for all lines of insurance. Being a Top Claims Executive directs the review and settlement of complex or high dollar claims. Develops procedures and policies to enhance and improve the processing, investigation, and settlement of claims. Additionally, Top Claims Executive ensures legal examinations are made when appropriate. Requires a bachelor's degree. Typically reports to top management. The Top Claims Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. Comprehensive knowledge of the overall departmental function. To be a Top Claims Executive typically requires 8+ years of managerial experience. (Copyright 2024 Salary.com)
Under the supervision of the Manager, the incumbent adjudicates claims and provides phone and/or casino onsite coverage for all member and provider interactions. Accountable for the status of claim age for all group evaluation and daily work flow. Makes adjustments daily to ensure standards are met. High school diploma or GED; one year of college level anatomy or pre-med classes or advanced medical terminology training, including ICD10 and CPT Coding; minimum two to four years’ experience in medical claims processing; word processing and data entry skills; Must have the ability to train employees and familiarity with HIPAA guidelines. Experience with Trizetto QicLink or VBA claims system preferred.
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